Pediatric CI therapy for stroke-induced hemiparesis in young children.
Pediatric CI therapy for stroke-induced hemiparesis in young children.
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DOI：
10.1080/13638490601151836
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发表时间：
2007-01-01
影响因子：
1.3
通讯作者：
Law, Charles R
中科院分区：
文献类型：
--
作者：
Taub, Edward;Griffin, Angi;Law, Charles R
在这个实验室中，我们已经开发了一套技术，随机对照研究和多地点随机对照试验表明，可以大大减少轻度至重度慢性中风成人患者的运动缺陷。在创伤性脑损伤和脑切除术后的成人患者中获得了等同的结果。被称为约束诱导运动疗法或CI疗法的基本技术直接来自于对具有成熟运动系统的猴子以及在出生当天或产前通过子宫内手术程序给予手术干预的猴子的基础研究。我们在此报告了两项随机对照试验的结果，一项研究是对8个月至8岁的不同病因的不对称上肢运动缺陷的幼儿进行CI治疗，另一项研究是对2至6岁的因产前、围产期或产前早期卒中而发生轻偏瘫的儿童进行CI治疗。用于儿童的程序与用于成人的程序非常相似，只是为了使基本技术适合年龄而有所不同。到目前为止，所有形式的上肢CI治疗都涉及3个主要要素：（1）对受影响较大的肢体进行强化训练，（2）对受影响较小的肢体进行长期约束，（3）将实验室中获得的治疗收益转移到生活中的“转移包”技术。脑瘫患儿的治疗效果明显好于成人。在实验室中观察到的运动质量发生了显著变化，这些变化由蒙面观察者从录像带中进行评分;在生活情况下，受影响更严重的手臂的实际使用量;活动范围;以及出现了以前从未进行过的新行为类别，例如在个别病例中，精细的拇指-食指抓握、旋后和使用受影响更严重的肢体爬行，手掌放置和节奏改变。在第二个实验中，对照组在接受常规和常规护理6个月后，被交叉接受CI治疗，并表现出与首先接受CI治疗的儿童一样好的结果。治疗结束后6个月，治疗增益的保留率约为70%。对于一些儿童有没有减少保留，而对其他人有一个显着的下降。其中一个重要的因素，有助于良好的保留是父母的依从性与建议的治疗后方案。当记忆力不好时，复习期可能是有价值的。在第一个实验中，儿童连续21天每天6小时接受治疗，而在第二个实验中，治疗仅发生在3周治疗期（15天）的工作日。治疗15天的结果至少与连续21天一样好，从而使该方案适合于通常的治疗师工作周，并使其更实用，临床使用成本更低。CI治疗不能使不对称性上肢运动障碍的脑瘫患儿的运动恢复正常。然而，正如在本实验室进行的那样，它可以在大多数情况下产生实质性的改善。
In this laboratory we have developed a set of techniques that randomized controlled studies and a multisite randomized controlled trial have shown can substantially reduce the motor deficit of adult patients with mild to severe chronic strokes. Equivalent results have been obtained with adult patients after traumatic brain injury and brain resection. The basic technique, termed Constraint-Induced Movement therapy or CI therapy was derived directly from basic research with monkeys with mature motor systems and with monkeys given surgical intervention either on their day of birth or prenatally by intrauterine surgical procedures. We report here the results of two randomized controlled trials of CI therapy with young children with asymmetric upper extremity motor deficits of varied etiologies from 8 months to 8 years of age in one study and with children with hemiparesis consequent to prenatal, perinatal, or early antenatal stroke from 2 to 6 years old in a second study. The procedures used with children are very similar to those used with adults and diverge simply to make the basic techniques age-appropriate. All forms of CI therapy for the upper extremity to date involve 3 main elements: (1) intensive training of the more affected extremity, (2) prolonged restraint of the less affected extremity, (3) a 'transfer package' of techniques to induce transfer of therapeutic gains achieved in the laboratory to the life situation. The results in children with cerebral palsy are considerably better than those obtained in adults. Marked changes were observed in the quality of movement in the laboratory scored by masked observers from videotape; actual amount of use of the more affected arm in the life situation; active range of motion; and emergence of new classes of behaviour never performed before, such as in individual cases, fine thumb-forefinger grasp, supination, and use of the more affected extremity in crawling with palmar placement and rhythmic alteration. In the second experiment, the control group, after receiving usual and customary care for 6 months, was crossed over to receive CI therapy and exhibited results that were as good as those for the children receiving CI therapy first. Retention of treatment gains was approximately 70% at 6 months after the end of treatment. For some children there was no decrement in retention while for others there was a marked drop-off. One of the important factors contributing to good retention was the compliance of parents with the recommended post-treatment regimen. When retention is poor, brush-up periods may be of value. In the first experiment children were treated for 6 hr/day for 21 consecutive days, while in the second experiment treatment occurred only on the weekdays of the 3-wk treatment period (15 days). The results were at least as good with 15 days of treatment as with 21 consecutive days, thereby allowing the protocol to be fit into the usual therapist work week and making it more practical and less expensive for clinical use. CI therapy does not make movement normal in children with cerebral palsy with asymmetric upper extremity motor disorders. However, as carried out in this laboratory, it can produce a substantial improvement in a majority of cases.